In a study that looked at what factors might affect whether or not a patient receives intensive medical procedures in the last 6 months of life, investigators found that older age, Alzheimer’s disease, cancer, living in a nursing home, and having an advance directive were associated with a lower likelihood of undergoing an intensive procedure.

In contrast, living in a region with higher hospital care intensity and black race each doubled a patient’s likelihood of undergoing an intensive procedure.

“It’s pretty striking the extent to which nonclinical factors–such as where you live and what race you are–appear to influence your chance of undergoing an invasive and potentially uncomfortable procedure at the end of life,” said MD candidate Evan Tschirhart, lead author of the Journal of the American Geriatric Society study.

“This suggests we may not be doing enough to ensure that patients get treatments that best match their values and goals.”